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To the Editor:
“Terminal extubation” is a form of euthanasia, and neurologists should recognize it as such. Withdrawal of ventilation directly results in the death of the patient. Death occurred within 1 hour of extubation in 25% of the subjects in the Mayer and Kossoff study1 confirming that these patients needed ventilatory support to survive. It is not surprising that many physicians are reluctant to perform “terminal extubation” because it goes directly against one of physicians’ most preciously guarded principles (“first do no harm”).
Neurologists up to now have been protective of comatose patients on ventilatory support. Brain death criteria2 were developed for use in the intensive care unit by neurologists who acknowledged their duty to guard a patient’s life against premature extubation. In a momentous volte-face, patients are now extubated to bring about their death, and the only justification is a surrogate’s subjective concern that the patient will survive with poor quality of life. We have lost the true understanding of how precious life …
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